不同抗凝剂及透析膜对维持性血透患者止凝血状态的影响

目的观察不同抗凝剂及透析膜透析对维持性血液透析(MHD)患者止凝血状态的影响。方法10例MHD患者通过自身对照，先后给予普通肝素(UFH)、低分子量肝素(LMWH)抗凝以及醋酸膜(CA)、聚砜膜(PS)进行血液透析治疗。患者分为UFH-CA组、UFH-PS组、LMWH-CA组、LMWH-PS组等四组，检测其血浆D-二聚体，GMP-140及APTT、血清BUN水平。结果透析前各组血浆D-二聚体、GMP-140水平及APTT间差异均不显著。透析后，各组血浆D-二聚体及GMP-140显著升高（P＜0.05），其中GMP-140升高幅度UFH-CA组显著高于其他三组（P＜0.05），UFH抗凝组较LMWH抗凝组APTT明显延长（P＜0.05）。透析器复用三次后，KT／V均明显下降（P＜0.01），UFH抗凝组较LMWH抗凝组下降明显（P＜0.05）。结论PS膜对血小板的活化作用弱于CA膜；与UFH相比，LMWH抗凝对纤溶系统、血小板及APTT的影响较小，有助于改善透析膜生物相容性和减少出血倾向。

The effects of different anticoagulants and dialyzer membranes on hemodialysis in patients with maintaining hemodialysis

Objective:To investigate the effect of different anticoagulants and membranes on hemostasis abnormalities of end stage renal failure patients with maintaining hemodialysis(MHD). Methodology:This we randomized self controlled study.Ten MHD patients were dialysed with unfraction heparin (UFH) or low molecular weight heparin (LMWH) as anticoagulant and cellulose acetate (CA) or polysulfone (PS) as dialysis membrane.Those patients were divided into four groups including UFH CA,UFH PS,LMWH CA and LMWH PS.The plasma D dimer,granular membranous protein 140(GMP 140),activated partial thromboplastin time(APTT) and blood urea nitrogen (BUN) were measured by routine methods. Results:There were no significant differences on predialysis hemostatic parameters among four groups.After dialyzing,plasma D dimer and GMP 140 increased markedly( P <0 05),and the increments of GMP 140 in UFH CA group were higher than that in other three groups ( P <0 05).In UFH groups,APTT prolonged significantly as compared with that in LMWH groups ( P <0 05).The KT/V decreased markedly( P <0 01)after dialyzers reused for three times,and the descending rate of KT/V in UFH groups were much higher than LMWH groups( P <0 05). Conclusion:During hemodialysis,platelet is more activated by using PS membrane than by CA membrane.Compared with UFH,LMWH had less affects on fibrinolysis system and platelet and APTT.It will contribute to improve the biocompatibility of extracorporal circulation and avoid hemorrhagic tendency.